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NPI Code Detail

MEDICARE: KELLY J BEAN NP

MEDICARE: KELLY J BEAN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner71002643AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000568239OTHERINANTHEM

General Provider Information

NPI Number : 1720246010
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY J BEAN NP
Provider Business Mailing Address
First Line : PO BOX 637764
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-7764
Country : US
Telephone Number : 317-880-3939
Fax Number :
Provider Business Practice Location Address
First Line : 2700 DR MARTIN LUTHER KING JR ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46208-5019
Country : US
Telephone Number : 317-931-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2008
Last Update Date : 09/10/2025

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